Category: Medicine


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Instructions and Notes:
1)      Overview of QHP Landscape files
This website contains plan information for states in Federally-Facilitated and State-Partnership Marketplaces.
·         Medical plans in the individual market;
·         Medical plans in the small group (SHOP) market;
·         Dental plans in the individual market; and
·         Dental plans in the small group (SHOP) market.
2)      Identifying plans based on geography and plan criteria
To browse for a plan by specific data fields, click on the icon at the top of the column for a specific field of interest such as state, county, or metal level.  For example, to select a specific county of interest, select the county name from the drop-down menu in the second column and click “OK” when done. The file will filter the data and show plan information only for the selected county.   Multiple data fields may also be selected for browsing at one time.
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Premium amounts do not include tax credits that will lower premiums for the majority of those applying, specifically those with income up to 400 percent of the federal poverty level.
The document shows premiums for the following example rating scenarios below:
·         Adult Individual Age 27 (column H) = one adult age 27
·         Adult Individual Age 50 (column I) = one adult age 50
·         Family  (column J) = two adults age 30, two children
·         Single Parent Family (column K) = one adult age 30, two children
·         Couple (column L) = two adults age 40, no children
·         Child (column M) = one child any age
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++   Premiums forthcoming
Note:  This document includes data from plans in the Federally-facilitated and State-Partnership Marketplaces. Those data were pulled from the Health Insurance Oversight System (HIOS) for Federally-facilitated states, and from the System for Electronic and Rate Form Filing (SERFF) for the partnership states.  They are current as of September 27, 2013, and are subject to change. For counties in Alaska and Nebraska, the premium rates shown are for the rating area within that county with the highest population.  For counties in all other states, the premiums shown are for all persons residing in that county. The premium amounts do not include tax credits that will lower premiums for the majority of those applying, specifically those with income up to 400 percent of the federal poverty level.

UPDATE II

Uga VIII was laid to rest at Sanford Stadium on Saturday. On hand were members of the Seiler family, and two of Uga VIII’s veterinarians, Dr. Amanda Perry and Dr. Bruce Hollett of UGA’s College of Veterinary Medicine, who was the inspiration for Uga VIII’s AKC-registered name, Big Bad Bruce.

Speaking on behalf of the family, Wendy Seiler – whose husband Charles is the mascots’ chief handler – read the eulogy to Uga VIII:

“Just two months ago, Uga VIII was getting settled in our home. He seemed to take great pride in rearranging our furniture and redistributing our son’s toys in a neat pile in the backyard. “Uga VIII never really got a chance to get used to the game day experience. . . .but he accepted the challenge and took his place along the sideline to carry on the honored tradition. It is sad to watch a young, vibrant dog get sick and have to face such a terrible disease. We are fortunate that Uga VIII passed away in his sleep, on his bed, with his toys.”

The Seilers issued special thanks to their Savannah veterinarian, Dr. Stanley Lester, and to a number of UGA administrative and athletic personnel, including President Michael F. Adams, football coach Mark Richt, athletic staff members Charley Whittemore and Kenny Pauley, and Athletic Director Greg McGarity, who made the necessary arrangements for Uga VIII’s burial.

UPDATE

Big Bad Bruce has passed away…

ATHENS — Uga VIII, the white male English Bulldog mascot of the University of Georgia, passed away early Friday. He had been diagnosed with lymphoma in early January of this year. No formal funeral ceremony is scheduled.

Born Sept. 12, 2009, Uga VIII had been introduced to the Bulldog Nation Saturday, Oct. 16, during pre-game ceremonies of the Georgia-Vanderbilt game in Sanford Stadium. He served the final six regular season games of 2010.

According to the Frank W. “Sonny” Seiler family, long-time owners of the Bulldog line of mascots, “Russ” will serve again as the interim mascot. Russ served as interim mascot the final two games of 2009 and the first six games of 2010 prior to Uga VIII being introduced. The continuous line of Georgia Bulldog mascots have been owned by the Seiler family for more than 50 years.

UGA VIII has lymphoma, is responding well to treatment

AJC – By Kristi E. Swartz

Uga VIII, the University of Georgia’s beloved mascot, has been diagnosed with lymphoma, the university said in a news release Friday afternoon.

The English bulldog is responding well to treatment and is expected to continue his appearances at athletic events “as his health allows,” the release said.

Lymphoma is a type of blood cancer that occurs when white blood cells that help protect the body from infection and disease begin behaving abnormally.

Canine lymphoma is defined as the occurrence of malignant tumors in a dog’s organs, usually in the lymph nodes, liver, or spleen.

Uga VIII took over as Georgia’s mascot at the Oct. 16 homecoming game.

The dog missed the Liberty Bowl on Dec. 30 because of a gastrointestinal condition that prevented him from traveling with the football team. Further diagnostic tests revealed the more serious medical condition, the university said.

Uga VIII is being treated by university specialists at UGA’s College of Veterinary Medicine, according to the university.

The dog’s primary veterinarian is Dr. Bruce Hollett, who has provided medical care for the dogs in the Uga line for years, according to Uga’s owner, Sonny Seiler.

The AJC has attempted to contact Seiler and the College of Veterinary Medicine. A spokesman for the university said the school will not give specifics about Uga’s condition, citing HIPAA laws. HIPAA is the the federal Health Insurance Portability and Accountability Act, which guards privacy of medical records.

If Uga VIII is unable to appear at athletic events, Russ, the half-brother of Uga VII, will fill in for him, the university said.

Russ filled in at the final two games of the 2009 season following the death of Uga VII as well as the first six games of 2010. He also was present at the Liberty Bowl game last month because of Uga VIII’s illness.

Uga VIII’s registered name is Big Bad Bruce. He is the great-great-great-great-great-grandson of the original Uga, who reigned from 1956-66, and is the grandson of Uga VI. He was born Sept. 12, 2009, and weighs 55 pounds.

Russ was 4-4 after taking over from his half-brother Uga VII, who died of heart-related causes Nov. 19, in just his second year.

Uga VII was 16-7 after taking over for Uga VI, Georgia’s winningest mascot at 87-27 from 1999-2008.

Frank W. “Sonny” Seiler, the longtime owner of this line of English bulldogs, had this to say about Uga VIII last November:

“He is every bit as good as his predecessors and probably exceeds them. He is a good-looking dog and in excellent health. He has two more months to grow and fill out. He won’t get any taller,” Seiler told the AJC.

“He has a great head. He resembles his grandfather, Uga VI. It’s easy to get their pictures mixed up, which is what we want. We had a choice of three puppies directly descended from Uga VI, and he’s certainly lived up to the expectations so far,” Seiler told the AJC.

General Overview Of Canine Lymphoma

Canine lymphoma (also called lymphosarcoma) is the most common type of cancer to affect dogs. Lymphoma is defined as the occurrence of malignant tumors in a dog’s organs, usually in the lymph nodes, liver, or spleen. Lymphoma can also be present in the digestive tract, as well as in the eyes and skin.

The first documented case of canine Lymphoma was in a nine-year old crossbred dog, in the late 1980’s. It was identified in the dog’s prostate, and treatment was attempted with cytotoxic drugs. Since not much was known about this condition, the dog did not survive. With today’s technology and veterinary medicine, there is a fairly high remission rate with Canine Lymphoma.

The life expectancy of a dog diagnosed with lymphoma is between 9 and 12 months. While this may seem discouraging, it is possible to send a dog’s lymphoma into remission with constant medical care, and regular chemotherapy.

With proper care, the survival rate of a dog diagnosed with lymphoma can be raised to 50%. With intensive chemotherapy, the average chance of remission is from 60-90%. Without treatment, most dogs will only survive for an average of two months.

Canine Lymphoma can be present wherever there is lymph tissue in your dog’s body. It can travel quickly, especially if your dog is under significant stress. Lymphoma causes death in the same way that many other cancers do: by inducing organ failure.

Though lymphoma may sound like a fatal condition, it actually has a much higher remission rate than some other cancers that can affect dogs. With a prompt diagnosis, as well as an intensive treatment plan, the chances of survival are moderately good.

Chemotherapy generally refers to the treatment of cancer with powerful drugs that kill cells. These drugs are used to kill the cancer cells, but can harm healthy cells as well (which causes the side effects associated with this treatment). Combination chemotherapy usually involves chemotherapy drugs in addition to radiation treatment, which is usually the most effective against canine lymphoma.

The chemotherapy process for dogs is slightly less intensive than chemotherapy in humans, since the dosage ratio of the cell-killing drugs is much lower.

Chemotherapy drugs are targeted to be the most toxic to fast-growing cells, such as cancer cells. However, the cells in your dog’s hair follicle are also fast-growing, and are particularly susceptible to damage by cytotoxic drugs.

In dogs, the areas most commonly afflicted with hair loss are around the face, paws, and in local regions near the malignant tumor(s).

If you haven’t heard what Fran Tarkenton had to say regarding Mark Richt last Friday on 680 The Fan, you probably should. The most famous former Georgia Bulldog (non-Herschel division) eviscerated the Bulldogs’ coach and strongly suggested the program needs a new leader.

Francis T. began boldly — “What has happened over the last week with Georgia has been the most disturbing time I have seen in a long time; you know, people don’t want to look at reality” — and didn’t pause for breath. (A partial transcript is available at SportsRadioInterviews.com.)

Richt’s all-is-well press briefing of Jan. 4 apparently set Tarkenton’s teeth to gnashing. Concerning the announcement that Richt would re-immerse himself in the finer points of football, Tarkenton said this:

“Holy cow! Yesterday, where Mark Richt says, ‘I have been freed from administrative duties to spend more time on football.’ Then I quote him, he said, ‘The moves give [me] more time to study the game of football and be an expert and be on the cutting edge.’ What has he been doing for nine years? I have never heard any college, high school, professional coach [say] that [he] was not able to spend enough time on football.”

Asked by host Christopher Rude if Rich might have been devoting too much time to academics or somesuch, Tarkenton said:

“No, it sounds like a cop-out! It sounds like, ‘I am not taking responsibility. I have other things.’ We hire people to be football coaches. We pay him and others millions of dollars to be football coaches, not to be administrators.

He didn’t do a very good job there — we had 12 people arrested this year, including a top-ranked quarterback who was a top kid that is now going to play LSU [Zach Mettenberger], and that has been going on forever.

“[Richt] is a wonderful guy. He is a good Christian guy. He wants to be a missionary. He goes on missions. That is a wonderful thing. But do you know the religion of Nick Saban? Or Gus Malzahn? Or Chip Kelly playing for the national championship?

I don’t think we care what their religion [is]. We hire them to be football coaches. If we are hiring religious instructors, let’s go to the Candler School of Theology over here in Decatur and get some of their people to come and coach our football team.”

Let the record note that Tarkenton is himself the son of a preacher. Which isn’t the same as being the son of a diplomat, and is evident throughout this diatribe. More Fran:

“You’ve been there nine years [10, actually] and you say [you] haven’t had time to spend on football — if you don’t think that’s a problem, Georgia people, and [athletic director] Greg McGarity, if you don’t think the signs are there, my friend … Bad news does not get better with time.”

Regarding last week’s announcements that two top in-state prospects plan to sign with Alabama and Auburn, Tarkenton said:

“We’re going to lose the elite players this year. We haven’t in the past — we’ve gotten the elite player. We either didn’t choose right or we didn’t coach right, because we didn’t have success.

“Right now our program has had three years of regression, and I don’t see any way this thing is going to get out of the ditch. When I read comments like [Richt’s] … we’re putting spin on everything.

In the meantime Alabama and Auburn and Tennessee are working and kicking our butts and recruiting people and getting coaches that have spread offenses. I mean, can you imagine? We scored two field goals against Central Florida.”

The son of a preacher then offered a benediction:

“I think Greg McGarity has got to look at this awfully hard, I think the signs are that we have a program that is in big trouble.”

And now you’re asking: How noteworthy is this? My answer: Very. It’s one thing for some newspaper guy (like this one) to carp about Richt, quite another for a most distinguished alum to sound the alarm. In the space of nine minutes, Sir Francis essentially said what more and more folks are thinking: That Georgia needs a new coach.

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Related Links:

Grantham a DC Candidate in Dallas?

The Curse of Colt Brennan

Related Previous Posts:

Money Games…

Georgia Bulldogs 2010: Time To Put On The Silver Britches…

Cam Newton: The Son Of A Preacher Man…

A Few Dog Stories: Winston, Champ, Mara, And Russ

Sunday Diversity: Green Living, The Group Of Death, And Southern Dogs

Uga VII Is Dead!

Pray for UGA VIII

end – ;(


The cost of Medicare is a good place to begin. At its start, in 1966, Medicare cost $3 billion.

The House Ways and Means Committee estimated that Medicare would cost only about $12 billion by 1990 (a figure that included an allowance for inflation). This was a supposedly “conservative” estimate.

But in 1990 Medicare actually cost $107 billion

Democrats and the CBO’s ObamaCare numbers

American Thinker – Yossi Gestetner

During ObamaCare debates, past and present, Democrats point to the estimates of the Congressional Budget office which show that enacting Health Care Reform gives the U.S. $143 billion in savings over the first ten years (starting in early 2010), and repealing ObamaCare would ‘wipe-out’ these very savings.

The crucial thing to understand is that the CBO is just a calculator: It only adds and subtracts the numbers Congress gives it. For example, a bill — to be called ObamaCare — that has $857 billion in expenses over the first ten years; approximately $500 billion in tax increases, in addition to approximately $500 billion in Medicare cuts over the same period, will give you a savings of $143 billion. This is what the CBO tells you. However, the CBO will not be there to make sure that the planned Medicare cuts indeed take place or that the tax increases will be enacted.

Therefore, Democrats are ignorant about the workings of the CBO or are — more likely — blatantly misleading the public when they point to the CBO’ estimates of costs and ‘savings.’ These very Democrats voted multiple times — after ObamaCare passed — to push back until 2012 the 21% cut in pay for Medicare doctors which, according to ObamaCare, should have taken place in early 2010.

The initial goal of letting the 21% cut take place was one of ObamaCare’s money saving moves ($15 billion annually, according to this Reuters report). However, these ‘savings’ (approximately $150 billion over ten years if the cuts never takes place), were dumped off the bus as a step one to go around ObamaCare, yet Democrats still wave the $143 billion in ‘saving’ that the law will bring over the first ten years starting a year ago.

The 21% cut that was pushed back for a total of two years (thus $30 billion in savings is already gone), is just one of many Medicare cuts that ObamaCare will not be able to follow through, certainly not for extended periods of time, as estimated by the Medicare Actuary; you know, the guy who actually does analyze what cuts can or cannot take place in Medicare, and does not just glaze at the numbers as the CBO does as a Texas Instrument device of thirty years ago.

For good reason did Medicare, as of now, land up to cost 9 times — or whatever exact amount — more than what the CBO estimated back in the 1960’s. Simple, the CBO is a calculator; not an enforcer.

Additional Information on CBO’s Preliminary Analysis of H.R. 2

CBO Director’s Blog

CBO and the staff of the Joint Committee on Taxation (JCT) have not yet developed a detailed estimate of the budgetary impact of H.R. 2, the Repealing the Job-Killing Health Care Law Act, which would repeal the major health care legislation enacted in March 2010.

Yesterday, we released a preliminary analysis of that legislation indicating that, over the 2012-2021 period, the effect of enacting H.R. 2 on the federal budget as a result of changes in direct spending and revenues is likely to be an increase in deficits in the vicinity of $230 billion, plus or minus the effects of forthcoming technical and economic changes to CBO’s and JCT’s projections for that period.

We have been asked to provide the revenue and direct spending components of that total. Extrapolating the estimated budgetary effects of the original health care legislation and accounting for the effects of subsequent legislation, CBO anticipates that enacting H.R. 2 would probably yield, for the 2012-2021 period, a reduction in revenues in the neighborhood of $770 billion and a reduction in outlays in the vicinity of $540 billion, plus or minus the effects of forthcoming technical and economic changes to CBO’s and JCT’s projections.



Obamacare in Pictures

The Budgetary Consequences of the President’s Health Care Overhaul

The President’s health care law is a budget buster. Claims of deficit reduction exclude the $115 billion needed to implement the law. The score double-counts $521 billion from Social Security payroll taxes, CLASS Act premiums, and Medicare cuts. It strips a costly doc-fix provision that was included in initial score. It measures 10 years of revenues to offset 6 years of new spending. There is no question that the creation of a trillion dollar open-ended entitlement is a fiscal train wreck.

Democrats continue to distort the consequences of their budget-busting health-care overhaul. Claims of deficit reduction often cite figures from the Congressional Budget Office, which reported last year that despite $2.6 trillion in new spending, the legislation as written would reduce deficits by $143 billion over ten years.
Source: http://www.cbo.gov/ftpdocs/113xx/doc11379/AmendReconProp.pdf

To hide the true cost of their health-care overhaul, the Democrats loaded the overhaul with gimmicks and double-counting – and the CBO must score what is put in front of it. But once these gimmicks are accounted for, the bill would add over $700 billion in red ink over the next decade, as health-care costs send the debt spiraling out of control.

The CBO score did not include the cost of setting up and administering the massive overhaul, including the cost of hiring new health-care bureaucrats to run the new spending programs, as well as thousands of IRS agents to enforce the new mandates.

The new law double-counts an estimated $521 billion in alleged offsets:

The Democrats’ bill originally included the “doc fix” that CBO estimated would add $208 billion to the bill’s score. Democrats removed this provision to lower the bill’s CBO score, but promised doctors that they would enact the fix later, and did in fact pass a short-term prevention of cuts to physician payments last year, adding to the deficit.
Souce: http://www.cbo.gov/ftpdocs/113xx/doc11376/RyanLtrhr4872.pdf

Add it up – $115 billion in discretionary costs, plus $521 billion in double-counting, plus $208 billion for a long-term doc fix (minus the $143 billion of claimed savings) – and the law would add $701 billion to the deficit over the next ten years.

In addition to the smoke and mirrors used to hide the deficit impact of the trillions of dollars in new spending, the law creates a brand new open-ended health care entitlement that will – unless repealed – exacerbate the spiraling cost of health care, explode our deficit and debt, and forever alter the relationship between the government and the American people.

Setting the Record Straight

Democrats’ Health Care Law is a Fiscal Train Wreck

Our dispute is not with the hard-working, non-partisan professionals at the Congressional Budget Office. CBO scores what is put in front of them – and what Democrats put in front of them last year was legislation packed with smoke and mirrors to hide the impact of trillions of dollars in new spending.

Nothing has changed about the flawed assumptions underlying CBO’s score – only the dates have changed. Undoing the Democrats’ massive new entitlement is essential to our fiscal health.


Claim: In his letter to Speaker Boehner, CBO director Elmendorf writes that the Democrats’ new health care law “would reduce budget deficits over the 2010-2019 period and in subsequent years; consequently, we expect that repealing that legislation would increase budget deficits.”

Response: The same budget gimmicks that allowed the Democrats to get a CBO score last spring saying that their massive entitlement expansion would somehow reduce the deficit are still in place today.  Nothing has changed about the underlying legislation.

Claims of deficit reduction are still excluding the $115 billion needed to implement the law. The Democrats are still double-counting $521 billion from Social Security payroll taxes, CLASS Act premiums, and Medicare cuts. The score still doesn’t account for the costly “doc-fix” provision that Democrats stripped out of the bill and passed separately.

CBO’s score of the GOP’s promised repeal of the Democrats’ costly new law is still taking all of these gimmicks into account.  Just as we disagreed with the underlying assumptions used to score the original legislation, we disagree with the underlying assumptions used to score the repeal of that same legislation.  There’s no new math at play here.


Claim: But now CBO says that the Democrats’ new law will reduce deficits by even more than before — $230 billion as opposed to $145 billion.

Response: The original score was based on a 2010-2019 estimate.  The repeal is based on a 2012-2021 estimate.  Thus, the scoring window has been moved two years forward. CBO’s estimates for the years beyond 2019 are based on the same smoke-and-mirrors budgetary gimmicks that produced the initial estimate. Again, nothing has changed about the underlying flawed assumptions. Only the dates have changed.

While the out years contain more fake deficit reduction, they also contain very real spending increases as the bill’s new subsidies and its expansion of Medicaid to childless adults continue to generate enormous costs. Moving past 2019 begins to give us a clearer picture of the total 10-year price tag of the bill – it will almost certainly be larger than $1 trillion, and will likely be closer to $2.6 trillion once a full 10 years of new costs are taken into account.


Claim: You can’t pick and choose which CBO scores you agree with.

Response: CBO must score what’s put in front of them.  Our disagreement is not with the non-partisan professionals at CBO but with the Democrats who employed smoke-and-mirrors gimmicks to attain a score that would show a deficit reduction.


Labor Markets and Health Care Reform: New Results (PDF)

Obamacare: A Budget-Busting, Job-Killing Health Care Law (PDF)

end

Senate Democrats Jump on Health Insurance Increases

WSJ – By Janet Adamy

Senate Democrats are jumping into the fight over a recent round of insurance rate increases – and this time, they are singling out specific insurers.

Senate Finance Committee Chairman Max Baucus and Senate Commerce Committee Chairman Jay Rockefeller sent letters warning five insurance companies against telling consumers their rates are going up because of new mandates in the health law. “This level of misinformation is not acceptable,” the Democratic senators wrote….

For Immediate Release September 20, 2010

Contact:  Scott Mulhauser/Erin Shields (Baucus) 224-4515 – Jena Longo (Rockefeller) 224-8374

Baucus, Rockefeller Demand Transparency from Insurance Companies on Premium Increases

Finance, Commerce Chairs tell insurance companies false statements, unjustified premium increases will not be tolerated

Washington, DCSenate Finance Committee Chairman Max Baucus (D-Mont.) and Senate Commerce Committee Chairman John D. (Jay) Rockefeller IV (D-West Va.) sent a letter today to insurance companies with the five largest enrollments in the country demanding more transparency in calculations of premium increases.  The Chairmen said today that they planned close oversight of the companies’ assertions about why premium increases might be necessary.  The Senate leaders also made clear they would not tolerate false statements about the effects of the new health care law on premiums, especially since non-partisan, independent experts have concluded the Affordable Care Act will not result in large health insurance premium increases.

“The era of egregious insurance company abuses is over,” said Baucus. “The Affordable Care Act shines a bright spotlight on insurance companies and gives us the tools to put an end to unjustified rate increases and consumer exploitations.  We simply will not tolerate deliberate misrepresentations and misinformation about the new health care law.  The truth is that the health care law increases the value people receive from their insurance, lowers out of pocket costs and provides consumers with free preventive care.  Independent experts have concluded that the law does not cause large premium increases, the American people deserve to know that and we’ll keep working to make sure they do.”

“It is unfathomable to me that while health care companies continue to post record profits they would think to raise premiums for American consumers, all the while blaming rate hikes on a law that improves our health care system, and will lead to a better life for families everywhere,” said Rockefeller. “It’s wrong and shameful. I want health insurance companies to be transparent and honest when increasing premiums – and health care reform is simply not to blame.  I will continue to do everything in my power to see that consumers are treated fairly, that they are put first, and receive decent, affordable care – always.”

The letter was sent to executives at WellPoint, United, Aetna, Health Care Services Corporation, and CIGNA.  The full text of the letter follows here.

Dear [Insurance Executive]:

We write to you concerned about unnecessary premium increases in 2011 and reports that insurance carriers are attempting to blame these premium increases on the enactment of the Patient Protection and Affordable Care Act (Affordable Care Act). Your company has one of the five largest enrollments, which is why we are writing to you.

Unjustified premium increases from the health insurance industry are nothing new. While the economy has struggled, and individuals and families across the country experience what are often record premium increases, the health insurance industry has prospered. We have consistently called attention to reports that some major insurers have radically increased profits and reserves from the 2009 calendar year – many over 25 percent.  These increases were clear indicators that insurance companies would not have to significantly increase rates for the next year.

Rather than look to throw consumers a life line, early reports indicate that some carriers are looking to raise rates even further in 2011, while blaming the patient protections in the Affordable Care Act for these cost increases. This is irresponsible and unacceptable but is not, unfortunately, surprising –  there were reports of health insurers immediately blaming double-digit premiums increases for 2010 on the Affordable Care Act when the premium increases were filed with state regulators months before the legislation was even enacted.

Many patient protections included in the Affordable Care Act take effect for plan or policy years beginning on or after September 23, 2010.  These provisions will not only increase coverage but will also end some of the insurance companies’ most egregious abuses.  For example, insurance companies will no longer be allowed to arbitrarily drop coverage, impose lifetime or restrictive annual limits on benefits, or deny coverage to children with pre-existing conditions.  Also, young adults will be able to stay on their parents’ plan until the age of 26 under all plans, and preventive services, like cancer screenings and vaccinations, will be covered at no cost under all new plans.

All told, it is estimated that the increased value of insurance coverage and the new consumer protections created under the Affordable Care Act taking effect this year will increase health insurance premiums by only 1 to 2 percent.  And, to balance this very modest increase, consumers can expect lower out-of-pocket costs for important services like preventive care and greater protection from financial ruin.

Health insurers should be transparent about the assumptions they use to arrive at their premium increases.  It is important for insurers to account for the difference between their calculations of premium increases attributed to provisions in the Affordable Care Act and those calculated by the Department of Health and Human Services (HHS) as well as many industry and academic experts.  Insurers should also account for the reasons why record industry profits and reserve levels have not resulted in lower premium increases.

If an insurer thinks it can blame the enactment of the Affordable Care Act for its rising premiums, it is surely mistaken. This level of misinformation is not acceptable.  As Chairmen of the Senate Finance Committee and the Senate Commerce Committee, we are committed to ensuring that consumers are treated fairly and will closely examine any potentially misleading communications to consumers.

And if an insurer thinks it can continue to impose double-digit premium increases, while providing fewer health benefits and enjoying record surpluses, it is again mistaken. There have been too many reports of insurance companies imposing insurance premiums increases at will with little oversight or public accountability. We are committed to ensuring that premium increases are fair and justified.

The Affordable Care Act promotes greater insurer accountability. Recently, HHS announced grants to states to bolster their review of proposed premium increases and a number of states have already enacted new laws to ensure fair and accurate premiums for consumers.  In 2011, the Affordable Care Act requires insurance companies to publicly justify premium increases that are deemed unreasonable and requires insurance companies to spend at least 80 percent of premium dollars on health care instead of administrative costs and overhead.  And, in 2014, the Affordable Care Act gives states and HHS the power to deny participation in insurance market exchanges to plans with a track record of unreasonable premium increases.

We have and will continue to strongly encourage states and HHS to use their existing authority as well as the authority created under the Affordable Care Act to its fullest to ensure that premium increases across the country are justified and communications are honest. We will continue to work toward ensuring that the federal and state governments have the necessary resources and authority to review potentially unjustified premium increases and to hold insurance companies accountable.

Insurers are an integral part of the success of The Affordable Care Act and we must work together to ensure that all Americans have access to quality, affordable health insurance.
Sincerely,

Max Baucus
Chairman
Committee on Finance

John D. Rockefeller IV
Chairman
Committee on Commerce
# # #

WSJ Commenter “Common Sense” wrote:

At their core, fully insured health plans are in the business of appropriately pricing risk. And it is not just their risk to profits (for the anti-insurance people) – it is risk to the policy holders that there is enough premium reserves to cover the cost of the medical expenses because PPACA requires them to cover more people and more services.

– Additional people covered (cover children up to age 26) = more medical expense with little premium increase
– More services covered (100% coverage of preventative care) = more medical expense
– Services covered to greater extents (no annual/lifetime limits) = more medical expense
– Required to let sick people jump in only when they need it (no pre-existing condition without a strong coverage mandate) = a lot more increase in medical expense in comparison to increase in premium

With the risk going up dramatically in multiple ways, what did you think would happen to premiums? Magic fairy dust would rain down and it would just all work out? You don’t get something (additional people and additional services) covered for nothing (premiums stay the same). The math doesn’t work.

When [medical expenses] > [premiums – admin – profit], then premiums rise. You can’t add additional medical expense without premiums going up.

Admin costs might come down a little, but in real world comparisons, they are already relatively low – as low as any comparable financial industry and where they do come down, expect lower admin service – to levels more like the government. Profits WILL come down some, but their margins are so thin in comparison to most industries (~4%), there is little room to go down and still stay in business, much less keep shareholders happy.

And you can complain all you want about executive pay, but in reality, while it may be a valid philosophical point (no one is worth those kinds of dollars), quantitatively, it would make no difference to healthcare if all the insurance executive pay went to zero. It is simply too little in comparison to the total cost.

The key purpose of the health plan is to pool the risk of individuals (which are generally have a low probability they will come true but have an unbearable cost if they do) and then fairly cover the agreed upon expenses for everyone. When you allow more risk in (no pre-existing conditions) at no additional cost and increase the amount of services covered (no limits, age 26, etc.), premiums are certain to go up. I think there were many people who stated this would happen BEFORE the legislation was passed.

Now the people in Congress who ramrodded this legislation through want to try to silence reality. No way! It is accountability time! It’s time to understand reality.

And by the way – making it not be private insurance companies (aka public option) still does nothing to change the equation other than exchange 4% profit for 40% inefficient government. WE still pay – probably a LOT MORE.

Related (WSJ): Health Insurers’ Move to Drop Child Policies Draws Criticism

Gateway Pundit: DNC Caught Promoting Anti-Beck Tea Party Rally

A New Strategy for Selling Health Care

TIME – By Kate Pickert

By now, most of us can agree that Democrats have largely failed to use health care reform as a political boost. The new law remains unpopular with half or more of the U.S. population and it will be one of several critical issues in the upcoming mid-term elections, particularly in districts where freshman, Blue Dog or vulnerable Democrats voted in favor of the Patient Protection and Affordable Care Act.

The law did pass, by the way. Apparently, a lot of voters don’t know this. Ben Smith of Politico got word of what was presented today on a conference call organized by FamiliesUSA, a powerful and well-funded grassroots group that advocated for reform and will provide support for messaging about the law as its implemented. A PowerPoint presentation discussed on the call led Smith to rightly note that a messaging shift on health reform is underway.

The PowerPoint slides were put together by a group called the Herndon Alliance, which does opinion research and counts as “partners” high-profile pro-reform groups like SEIU, AARP and the Center for American Progress. A spokesman for FamiliesUSA did not want to comment on the content of the presentation – which amounts to a back-stage pass to pro-reform messaging strategy – and said FamiliesUSA was not involved in assembling the presentation, merely that FamiliesUSA “provided Herndon the platform to present this information.”

In the presentation, which can be found on the Herndon Alliance web site, pro-reform advocates are advised to “avoid overheated rhetoric,” keep it simple and talk about the law as something that can be improved upon. It also acknowledges what now seems obvious: “Straightforward ‘policy’ defenses fail to be moving voters’ opinion about the law.”

Surprisingly, the presentation says that voters need to be reminded that the health reform bill actually passed the Congress and is now law. It says many “non-college educated women” and Latinos, in particular, don’t realize this. The really interesting material, however, can be found in a much longer Herndon document, also available online…

The longer version of the material includes lot more fascinating information, like that AARP has lost a lot of credibility as a trusted source, bashing insurance companies doesn’t really work anymore and elderly men are more skeptical of reform than elderly women…

Herndon Alliance’s new research results are in.

It’s a tough public opinion climate. But our newest reserach shows people can be moved from skepticism of reforms and support for repeal of the law to a position of resisting repeal and being open to reforms.

Check out a summary of our focus group research by Lake Research Partners, an overview of our Web polling research by Greenberg Quinlan and Rosner Research, and some high-level take-aways combining these findings, which we’ll be presenting in various forums in the coming weeks.

These and other materials are available in the “Resources” section of our Web site. While you’re there, check under “What’s New” for our most current information. You don’t have to be a partner to view our materials.

Why we hope you’ll join us

Together we can make high quality choices and affordable, accessible health care for all a reality.

How? By listening to what the American public really wants. We need to be trained and become skilled at engaging in the health dialogue where the public is in their thinking, not where we wish they were. Then we need to help the public expand their thinking on these issues through values-based messaging rather than shutting them down with fear or overly detailed policy discussions.

Herndon Alliance partners are doing just that.

We hope you’ll join us as we fix America’s health care system – together.




History of Herndon Alliance

In 2005 Herndon Alliance was established as a coalition of national and state based advocacy, labor, faith, provider, and business groups. The common vision was to reframe the healthcare reform discussion from one that was policy driven to one that is ‘values-based’ and would help a larger portion of the population understand how health care reform could improve affordability and security in their own health care coverage. Our goal was to increase the base of support for healthcare reform leading to quality and affordable health care for all.

What we learned was that 80% of polled Americans favored major healthcare reform. We also learned that this percentage radically dropped to below 30% when a specific policy was introduced. And finally, we learned that the vast majority of the voting population was already insured.

What we needed to hear was what the public wanted.

Two questions needed answering. How could we frame the issue of reform and access to health care to help those with insurance coverage understand that reform was critical for them? And, how could we move the population to create a majority of voters who, even when a policy was introduced, continued to favor healthcare reform?

In 2006 and 2007 we conducted research to answer both of these questions. We found that it was indeed possible to show those with insurance how important reform was for them, and that it was possible to move people toward supporting a specific policy for reform, if we framed the issues in specific ways that resonated with the public.

Herndon Alliance worked to make these finding public on state and national levels. We collaborated with our partner organizations to provide briefings to the staff members of presidential and congressional campaigns, coordinated with pro-reform organizations like AARP, SEIU, and many others, and trained advocates in messaging, always with the goal of ensuring that as many people as possible were talking about healthcare reform — together.

On March 23, 2010, the Patient Protection and Affordable Care Act was signed into law, guaranteeing security and stability for the insured and access for 32 million uninsured Americans for the first time in our nation’s history. This would not have occurred were it not for the tireless efforts by tens of thousands of advocates and millions of ordinary Americans, speaking together in a unified voice for reform.

Our work is far from over. Health care reform must now be properly implemented, and improvements must be made. If we are to preserve the gains made by the law and build on this foundation, the American public must understand what the law means for them. We must overcome fear and mistrust, and we must once again use our collective voice to connect with the public on the values we share as Americans.

Herndon Alliance Board of Directors

Carol Regan, PHI/Health Care for Health Care Workers – President of Board

Jennifer Ng’andu, National Council of LaRaza – Vice-President of Board

Philippe Villers, Families USA – Secretary and Treasurer of Board

Rob Restuccia, Community Catalyst – Board Member

Anthony Wright, Health Access California – Board Member

Staff

Bob Crittenden – Executive Director

Gwen Credit – Director of Operations

Sherry Prowda – Director of Communications

Francesca Holme – Project Director

Peter Van Vranke – National Outreach Consultant

Herndon Alliance Partners

AARP

AFL-CI

AFSCME

Alliance to Defend Health Care

Alzheimers Association

American Association of People with disabilities

American Cancer Society

American Diabetes Association

American Heart Association

American Medical Student Association

American Medical Women’s Association

American Nurses Association

America’s Agenda: Health Care For All

Asian American Justice Center

Avalere Health

Balanced Choice Health Care, Inc.

Beyond the Divide

Bi-partisan Policy Committee

Braid-Forbes Health Research

Brandeis University

Brookings Institute

Campaign for America’s Future

Campaign for Better Health Care

Catholic Healthcare West

Center for American Progress

Center for Community Change

Center for the Advancement of Health

Center on Budget & Policy Priorities

Champaign County Health Care Consumers

Children’s Defense Fund

Citizen Action of New York

Citizen Action of Wisconsin

Colorado Consumer Health Initiative

Commonwealth Fund

Communications Workers of America

Community Catalyst

Community Health Advocacy Partnership

Community Health Action Information Network (Florida CHAIN)

Community Partners

Community Service Society

Comunidades Unidas

Congress of California

Consumers for Affordable Health Care

Consumers Union

Dental Health Foundation

Democracy for America

Ecu-Health Care

Emory University

Families USA

Faithful Reform in Health Care

First Focus

Florida CHAIN

GRO-Grass Roots Organizing

Glover Park Group

Harvard University

HCAN

Health Access California

Health Action New Mexico

Healthcare for All

Health Care for Health Care Workers

Health Management Associates

Health Policy Alternatives

Health Policy Institute-Georgetown

Health Security for New Mexicans Campaign

Inova Fairfax Hospital Cancer Center

Institute for Healthcare Improvement

Institute of Medicine

Institute of Social Medicine and Community Health (SALSA)

Intermountain Health Care

IOM

Iowa for Health Care – SEIU

Jewish Community Relations Council of St. Louis

Jewish Council on Public Affairs

Jobs with Justice

Kansas Health Consumer Coalition

Legal Aid Society of Southwest Ohio LLC

Linguistica International

Maine People’s Alliance

Maine State Senate

Maryland Citizens’ Health Initiative

Metro New York Health Care for All Campaign

MDI Imported Car Service, Inc.

Medicare Rights Cente

Midwest States Center

Minnesota Senior Federation

Missouri Progressive Vote Coalition

MoveOn

NACHRI-Natl Assoc of Children Hospitals

National Association of Community Health Centers

National Association of CP Midwives

National Coalition on Health Care

National Council of La Raza

National Economic and Social Rights Initiative & National Health Law Program

National Physicians Alliance

National Women’s Law Center

New America Foundation

New Jersey Citizen Action

Northeast Action

Northwest Federation of Community Organizations

Northwest Health Law Advocates

Paraprofessional Healthcare Institute

Partners HealthCare

Partnership for Prevention

Pennsylvania Budget and Policy Center

Pennsylvania House Democratic Caucus

Pharmaceutical Care Management Association

PHI – Health Care for Health Care Workers Campaign

Physicians for Human Rights

PICO National Network

Planned Parenthood Federation of America

PPI’s Health priorities Project

Prescription Policy Choices

Princeton University

Progressive Majority

Progressive States Network

Progressive Strategies

Professional Healthcare Institute’s Health Care for Health Care Workers

Raising Women’s Voices for the Health Care

Rand Corp

Raven Analytics

RCHC

Research!America

Research Committee for Economic Development

RESULTS

Right On Time

Sargent Shriver National Center on Poverty Law

SEIU, Americans for Health Care

Small Business for Affordable Healthcare

Small Business Majority

TakeAction Minnesota

Tennessee Health Care Campaign

Tennessee Justice Center

The Access Project

The Commonwealth Institute for Fiscal Analysis

The Foundation for Taxpayer and Consumer Rights

The Hamilton Project

The Human Rights Implementation Project

The Mayo Clinic

The Moran Company

The National Academy for State Health Policy

The National Coalition on Health Care

The Opportunity Agenda

The pacific Business Group on Health (PBGH)

Tobacco Free Kids

UFCW-United Foods and Commercial Workers International Union

United Methodist Church/General Board of Church and Society

Universal Health Care Action Network (UHCAN)

University of Michigan

Universal Health Care Action Network – Ohio

Uplift International

USAction

Utah Health Policy Project

Vermont Citizens Campaign for Health

Vermont Public Interest Research Group

Virginia Interfaith Center for Public Policy

Volunteer Health Advocate

VoteHealthcare.org

West Virginians for Affordable Health Care

Working For Health Coalition

Wyrick Robbins Yates & Ponton LLP

Individual Partners

Gary Benjamin

John Carr

Lakshmi Sambhavi Cheemala

James Christian

Harold Cohen

Gwen Credit

Judith Darnell

Meredith Dodson

Melody Hart

Helen Haskell

Anne Joseph

Karen Metcaff

Alta Price

Don Schroeder

Paul Severance

Peter Wyckoff

end